Volume 23, Number 7
1999

When Pasteur demonstrated in the late 1800s that bacteria caused
disease, it took a long while for the public to get a clear idea of
what bacteria were and how they did what they did. In the 1930s,
many people thought you could catch conjunctivitis by looking at
someone who had an infected eye, and even today most people do not
know the best way to avoid infections in general.

Still, most people agree on the basics: You catch an infection
from other people, because a germ invades your body through broken
skin, the digestive system, or lungs. If it makes you very sick,
you go to a doctor, who will diagnose you and maybe take a blood
sample to confirm his diagnosis. Then he will treat you with drugs
or a shot of antibiotics and other therapeutic measures. He may
have to operate. You go to bed, and if you do not die, you will get
well, though you may carry scars (smallpox) or be otherwise disabled
(polio).

When people are made sick by mold, it's a whole new ball game.
You do not catch mold spores from other people the way you do germs.
You catch them from buildings, or the materials you work with. The
longer or more intense your exposure, the sicker you get. What
makes you sick is usually not the organisms themselves, but the
airborne toxins and allergens they produce. You may become so sick
that you have to go to bed, but your doctor will probably not know
how to diagnose you and you may look healthy to your friends. Even
if you do get diagnosed, your medical insurance will probably not
cover your treatment expenses. If you lose your job and your
health, and sue the landlord to get the money for medical expenses
and loss of income, chances are very small that you will win in
court, because it is virtually impossible to prove to a jury that
your health was damaged because of mold in the building. Juries need
the equivalent of a smoking gun, and so far, there is no foolproof
way to connect a moldy building with a sick person.

Even after you think you have recovered, you have not gained
immunity, as you do after you have had chickenpox or measles; in
fact, you may be more vulnerable to future exposures than you were
to start with, just as you would be after exposure to other common
toxins, such as lead.

(Gary Frost, in a recent letter about his own experience with
mold, concluded by saying, "Mold is certainly smart. It is stunning
to realize how opportunistic 'primitive' organisms are and how they
maximize any benefits from change in their environments. These
organisms don't need evolution.... They are responsive enough as
is.")

Besides the responsiveness, or adaptation to different conditions
that Gary mentions, they mutate with relative ease, and they
associate with other microorganisms in proportions that change as
the conditions change—i.e., as a location grows moister, the
proportion of Stachybotrys species will increase, and so on.
So it is hard to tell what you are dealing with.

In the tropics, the situation is even more serious. J. David
Miller, in his excellent paper, "Fungi as Contaminants in Indoor
Air," says,

In the cold climate of Canada, very few people encounter someone
who dies from a fungal disease. This is not the case in tropical
countries where diseases caused by fungi are common. There are a
number of invariably fatal systemic infections as well as skin and
nail mycoses and lung infections. Diseases caused by ingestion of
fungal toxins [i.e., eating spoiled food] are leading causes of
death in tropical and subtropical countries, especially liver cancer
induced by the ingestion of aflatoxins, esophageal cancer caused by
some Fusarium toxins and deaths caused indirectly by the
excessive consumption of immune system depressors such as the
trichothecenes (1).

Reports of Mold-Infested Schools and Homes

Papers given at conferences may give statistics on moldy homes
and schools as part of a larger picture, but somehow personal and
newspaper reports of individual schools and homes are better at
showing how mold can affect peoples' lives.

In a suburb of Dallas about six years ago, according to a 1997
report in the Fort Worth Star Telegram, health officials were
puzzled by the illness of a suburban woman, who had suffered from
flulike symptoms for two weeks after she moved into a condominium. A
regional industrial hygienist with the health department was quoted
as saying that "the neighbors found her crawling around on her hands
and knees complaining of earthquakes." Health officials
investigated her case and found that her illness was caused by
fungus in the air-conditioning ducts of her condo. The industrial
hygienist was quoted as saying, "She was totaled. Her system was
overwhelmed. She was in the hospital for 60 days before they got her
cleaned out."

The news report goes on to say that public knowledge of fungi
does not reach far beyond mushrooms, athlete's foot and yeast
infections, despite its deadly potential. Michael Rinaldi, a
mycologist at Audie Murphy Veterans Affairs Hospital in San Antonio,
is quoted as saying that in the last 10 years mycology, the study of
fungus, has become one of the most critical in all of medicine.

Susceptibility to fungus varies, it says. Infants, the aged,
asthma patients who are being treated with steroids, and people with
weakened immune systems are most susceptible. (The author failed to
mention one other important group: women. In some occupations they
are several times more likely to be affected than men.)

CNN Interactive, a website, had a story in November 1997 on a
post-flood case of Stachybotrys growth in West Bloomfield,
Michigan. The 14-month-old granddaughter had developed breathing
problems, and the grandmother was getting headaches and often felt
ill, especially when she was in the basement. These troubles came
after the spring rains that flooded the basement, bringing on the
growth of Stachybotrys, visible only as a small round black
circle on the wall.

Dr. George Riegel of Healthy Homes commented on this incident,
saying that few people who clean up after a flood do a professional
job and contain the area (with tape and plastic sheeting), with the
result that the mold spreads to other parts of the house. To remove
it safely, he said, would cost that family close to $10,000. He
also said that most black molds are not Stachybotrys.
Stachybotrys grows only on wood and paper products, and can
be found in only about 2 to 5 percent of American homes.

The grandmother said the news was rather unnerving. "I am ready
to move, but where am I going? This is my home. I can't afford to
just pack up and leave."

Hill Elementary School in Austin, Texas, was closed down at the
beginning of March and students assigned to other schools when mold
(a lot of Penicillium and a small amount of
Stachybotrys) was found in the outer rooms in the main
building. Further investigation revealed that the annex buildings
and portables also had mold.

As usual, in cases like this in which a thorough investigation is
done, several conditions were found to have contributed to the
overgrowth: a spring in the crawl space beneath the building after
rains (not a big problem); poor ventilation (air pressure higher
outside the building than inside—a big problem, because this
draws in contaminated moisture); condensation from cool roof beams,
which dripped into the school walls (since the moisture barrier at
that interface no longer was able to stop it); skylights (always
potential sources of water troubles); and (as in most schools),
outer walls lined on the inside with moisture-impermeable
chalkboards, bulletin boards and cabinetry, all of which tend to
trap the moisture within the walls.

Since the demolition is not complete yet, more pockets of mold
and decay may come to light. The outlying buildings (annex and
portables) have been found to have mold contamination too. The
school board has authorized the schools superintendent to spend a
million dollars to correct the problem. No one can be sure that the
building will be ready for the fall semester, four months away.

The children were getting sick and parents were complaining last
fall, months before the condition of the school was recognized as a
problem.

The local paper ran a letter to the editor recently from someone
who has been through this kind of crisis before. It says, in
part:

Stachybotrys was found in a Bryan school building in 1996. I
know because I was the principal. I requested environmental studies
be conducted by a biologic hazards company. Instead, the district
hired an industrial company unfamiliar with mold problems. Two
environmental specialists reviewed the findings and found
dangerously high levels of Stachybotrys as well as other molds. My
health deteriorated, and I was granted disability retirement by the
medical board of the Texas Teacher Retirement System because of the
effects of toxic exposure to Stachybotrys.

My heart goes out to the staff and students who are still in the
Bryan building.

A story about mold contamination of hospitals was sent to the
Aspergillus discussion list. It was from a subscriber in Finland,
replying in sympathy to someone who had observed water damage to
ceilings in five hospitals she had been in. The Finnish subscriber
said, "In my country too we have many mold-contaminated hospitals
(at least 3 central hospitals), unfortunately.

"One of my friends has been diagnosed with occupational allergic
alveolitis; she had been working in a mold-contaminated library,
which was closed later and the staff was moved to another building.
She complained that she got bad symptoms whenever she was in her
central hospital. All the staff, even doctors, denied mold problems
and said she was wrong. Now 3 wards of this hospital have been
closed for mold reparation!!!"

Another subscriber to the aspergillus mail list, Danitza
Shanahan, contributed the following story to the list March 9. She
saw it on page 24 of the Arizona Republic for March 5:

New Home Becomes a Horror

Mold Endangers Children's Health
A Mother's Dream
by Beverly Ford

When Michelle Harless finally scraped up the money for her first
house, she thought she was prepared for the rigors of home
ownership. But within months, her Glendale dream home became her
worst nightmare. The stuff of that nightmare: mold fed by a leaky
pipe.

Four months after moving into the three-bedroom house, Harless's
7-year-old son, Thomas Fuller, who suffers from cystic fibrosis, had
to be hospitalized. Two months later, he was hospitalized again.
Doctors said Thomas had lost 33 percent of his lung function because
of a common but sometimes toxic mold, called aspergillus.

"When it came back aspergillus we were blown away," said Harless,
26. Her 2-year-old son, James Hatley, wasn't immune, either. He
lost his appetite, developed red, cracked skin and began coughing
and sniffling. Doctors thought he was suffering from seizures.
Harless knew otherwise: It was aspergillus mold.

Then, she said, things went from bad to worse. Harless's
insurance company told her that her policy didn't cover mold
infestation. "I thought I did everything right," she said, "I had a
home inspection. I had homeowners insurance, I had a home warranty.
But it's a nightmare."

For weeks, Harless tried to convince the company that the mold
was caused by a leaky pipe, which was covered under her policy. But
the company stood firm. And despite her son's health problems, the
company refused to reimburse the family for moving into an
apartment, she said, or to pay to clean up the mold that had by now
permeated the home.

"I felt trapped," Harless said. "Mold affects healthy people,
but for my son it was a life-and-death matter."

The insurance carrier, Century National Insurance Co., declined
to comment on Harless's claims. It was only when an insurance
adjuster put up the money that Harless and her family were able to
move into a nearby apartment. Soon, both children's health
improved, although Thomas's lungs remain permanently damaged, she
said. Harless and her husband continue to make payments on the
$91,000 home while they wait to see whether their insurance company
will pay for repairs. The firm has sent inspectors to examine the
home and recently offered to work out a settlement.

A case similar to Michele Harless's, only worse, was reported in
USA Weekend for Dec. 3-5, 1999. It starts out this way:

"It started with a series of leaks. Within a year, Melinda
Ballard's 11,500-square-foot Texas dream home was quarantined; her
3-year-old son, Rees, was on daily medication to treat scarred,
asthmatic lungs; her husband, Ron Allison, had lost his memory along
with his job; and the family was living out of suitcases and locked
in a seemingly endless battle with their insurance company. The
problem? Household mold [Stachybotrys]."

This family is not poor: the house sits on a 72-acre estate in
Dripping Springs, west of Austin. She is described as an heiress.
But now she has to put on a HEPA mask in order to enter the house,
which she does once a week to check the air conditioning. The men
who are cutting out the moldy timbers have to wear moon suits. David
Straus, a mold expert with the Texas Tech University Health Sciences
Center, spent just 30 minutes inside the house, but was throwing up
hours afterward, and now has severe hearing loss in one ear from the
mold. The family suffered from headaches, dizziness and fatigue,
then respiratory and sinus problems, in addition to profusely bloody
runny noses and coughed-up blood.

The family is suing their insurance company (Farmers Insurance)
for $100 million, and the County District Attorney has initiated a
grand jury investigation to consider criminal charges against the
company.

Given the Usual Course of Events, What Options Do We Have?

If you suspect your building has a mild or moderate mold problem,
try to identify its source or sources so you can avoid them, or do
something about them, or direct the attention of technical people to
them. If you have been affected, your own reactions may be the best
indicator available. Take notes on the date, area, presence of
moisture (especially after a rain), any apparent mold growth, and
effect on you. Forget about setting out petri dishes or measuring
the humidity of the air.

Early recognition of a mold problem, and identification of its
cause and remedy, can keep the mold from getting a head start if you
have done your homework, provided the financing and approval for
assessment and remediation can be found. The above instances show
that residents and staff in a moldy building have no good options
left if the mold gets a head start. This situation may eventually
change when buildings are built and maintained to prevent moisture
accumulation, when doctors learn to recognize the effect of mold
exposure, when lawmakers require insurance companies to cover people
affected by a mold disaster, and when mycologists are able to make
an airtight causal connection between the presence of indoor mold
and the health of people who inhabit the same space. Any change
from the present situation will be an improvement. At present,
though, rich and poor alike have only one good option:
preparedness.

1. Maintain a list, compiled from references if possible, of all
the experts you may one day have to call on (an informed doctor, a
consultant who can assess the mold problem and advise on cleanup,
someone who is knowledgeable about construction of houses and
management of HVAC systems, etc.). The nearest one may be in
another town.

2. Gather information: Buy books on the topic, visit
informative websites, talk with informed people, get friendly with
the building engineer and competent local service people who
specialize in duct and carpet cleaning, join organizations that have
mold prevention and recovery on their agendas, e.g. C.U.R.E.
(Citizens United for Responsible Environmentalism, Inc., an
international nonprofit education and research organization based in
California, focusing on educating doctors and the public about mold
diseases and toxicoses—tel. 408/268-4085, fax
408/476-8552).

One book that everyone should have access to has just appeared in
print: Guidelines on Assessment and Remediation of Fungi in
Indoor Environments, available on the Internet at http://www.ci.nyc.ny.us/html/doh/html/epi/moldrpt1.html
(2) Future revisions to it will be posted there too. For more
information, contact the New York City Department of Health at
212/788-4290. An expert panel was convened in 1993, originally to
develop policies for medical and environmental evaluation and
intervention in cases of Stachybotrys atra [chartarum]
contamination. This revised guideline covers all fungi.

3. Follow developments in research and make contacts. Go to a
mold conference now and then, or read in the professional literature
on current research, to be sure your information is up to date. This
will also make people more willing to talk to you; you can put
yourself on a grapevine if you have recent news to swap. (As far as
I know, there are no extension or college courses on coping with
mold, except perhaps in the historical preservation field.)

4. Study real situations. Even if there is no leak to be found,
water can enter a building through porous building materials,
including concrete. It may enter as water vapor and condense and
collect in hidden places. There are many esoteric ways for water to
enter a house and feed mold. They are hard to understand without
some kind of hands-on experience or a good teacher or a couple of
really good books. So study is unavoidable.

5. If you have to leave your home or job despite everything, it
helps to be on good terms with family members and friends who might
be able to put you up in an emergency. A good savings account may
be more use to you than medical insurance.

Picking Up the Pieces

If the mold problem is not too bad, or if the source of the
problem is on neighboring property rather than inside your house,
you could do as several C.U.R.E. members have done: install
freestanding HEPA air filters in the office or bedroom, or even in
every room in the house. Central HEPA filter units, with their own
fan and air supply, can be installed as part of the central air
conditioner. They work best if you have a good air return system. A
good air filter large enough to handle a small or average bedroom
can be had for $150-190. It will not work, however, if you set it
on a deep carpet full of dust. This will just blow the dust up into
the air. Set it on a stool or chair.

If you get really sick from mold, the first thing to do is to
avoid further exposure (i.e., leave home or take extended leave from
your job). Then ask your friendly local mycologist to recommend a
good doctor. Or find an Internet list of doctors who can treat mold,
and be prepared to travel, because there may not be one in your
town. There are medicines nowadays that are effective against a
fairly broad range of mold species.

References

1. Atmospheric Environment Vol. 26A, No. 12, pp.
2163-2172, 1992.

2. Guidelines on Assessment and Remediation of Fungi in
Indoor Environments, available on the Internet at http://www.ci.nyc.ny.us/html/doh/html/epi/moldrpt1.html.
the printed version, 14 pp. long, is issued by the New York City
Dept. of Health, Environmental & Occupational Disease
Prevention, 125 Worth St. c/n 34C, New York, NY 10013. It is
intended for use by building engineers and management, but is
available for general distribution to anyone concerned about fungal
contamination, such as environmental consultants, health
professionals, or the general public.

Mold Websites & Listservs Related to Health

aspergillus-on@mail-list.com (A listserv for people diagnosed
with Aspergillus infections. A minor source of usable
information; mainly serves as a support group.)

http://www.aspergillus.man.ac.uk/ (A
technical website which offers an impressive variety of information,
including the full text of a large number of medical papers.
Registration is needed if you want to have access to all sections.)